What Effect Can Cauda Equina Negligence Have on Your Life?

How do you recover from medical negligence which leaves you with life changing injuries? Enable Law’s Senior Associate, Katherine Moyse, secured £2 million for one client. But, the compensation was only the start of repairing a life turned upside-down.

Our client, Richard (not his real name), suffered catastrophic injuries following a series of failures to diagnose and treat a developing syndrome known as cauda equina. Had hospital doctors acted on ‘red flag’ warnings on arrival, he would have been treated before any permanent damage occurred.

What Negligence Resulted in the Cauda Equina Claim?

Richard started to experience lower back pain – something people across the country experience daily. However, after a couple of weeks, the pain moved to his left leg and he was worried, so he went to his GP. The GP diagnosed sciatica; pain in the sciatic nerve which runs from the spine through the buttocks and usually one leg. He was prescribed pain relief and recommended physiotherapy.

That evening things took a turn for the worse. His pain became so bad that he called an ambulance and was taken to hospital. Over the next few hours, his right leg also became painful and he felt numbness in his bottom and was finding it difficult to go to the toilet.

He told the doctor in A&E about his symptoms and the doctor examined him. The doctor recorded in notes that Richard had reduced feeling around his bottom. However, he was examined 15 minutes later by a more senior doctor who recorded that the feeling around Richard’s bottom was normal.

Despite the pain in both of Richard’s legs, this doctor also diagnosed sciatica and sent him home. The doctor advised if he started to get any bladder or bowel problems, he should return to hospital immediately.

Richard went home in the early hours and went to bed. He woke up a few hours later to find he had wet the bed. He had no control over his bladder and was numb below the waist, so he could not feel he was wet. He phoned the hospital, explained that he had been seen by doctors at the hospital a few hours before and that since then, he had wet himself without realising. Rather than telling him to return to A&E, he was told the emergency department was very busy and that he should wait and come in the later in the day, when it would be quieter.

When he returned to hospital, the doctors correctly diagnosed possible cauda equina syndrome (which is a medical emergency requiring urgent surgery) and Richard was advised he needed an urgent MRI scan. As there was no MRI scanner at the hospital, he was told he would be transferred. However, in the end, there was a delay and he was not transferred until a further 17 hours had passed.

He was finally taken for an operation more than 48 hours after his first hospital visit. By this point, it was too late. Richard had suffered permanent damage which could not be reversed.

How Should His Cauda Equina Have Been Treated?

The independent medical experts in the case were clear the doctors who saw Richard on the first evening should have suspected his problems were serious and due to a developing cauda equina syndrome. Numbness in his bottom and pain and weakness in both legs were crucial signs, which should have raised the alarm in the minds of the A&E doctors. The doctors should also have arranged for him to have an urgent MRI scan which would have led to the correct diagnosis. The independent medical experts we instructed felt no reasonable A&E doctor would support the decision to send him home and therefore the treatment was negligent.

Another failure happened when he telephoned the hospital after wetting himself. This was a sign the cauda equina was worsening and he should have been told to come into the hospital immediately. It was also negligent that this did not happen.

These decisions caused a massive delay in Richard getting the right treatment and led to permanent damage which could have been avoided. If he had been treated correctly when he first went to hospital, he would have had surgery and suffered no permanent damage.

What Did The Spinal Injury Mean For Richard?

Richard suffers permanent injuries including:

• Pain, numbness and weakness in both legs and clawed toes. This means he has difficulty walking and suffers balance problems.
• No control over his bladder or bowel, and no sexual function.
• A significant psychiatric injury; he was depressed and struggled to adjust to his new life.

He could not return to work because his bowel function was so difficult to manage. He couldn’t feel when he needed to go to the toilet so had ‘accidents’ all the time. Because he was embarrassed about this, he spent much of the first two years after the negligence in his bedroom, so he could be close to a commode.

When he did go out, he had to wear pads all the time which regularly leaked, so he gradually stopped going out. About six months after the negligence took place, his long-term relationship ended.

As time went on, he became more alone and more depressed. His mental health became a big problem. He stopped caring for himself and stopped accepting help from others. Because the bowel incontinence was such a problem, he began to eat very little, in the hope this would reduce the problems. However, he became very unwell, malnourished and lost lots of weight.

What Help Was Available to Richard Through the Cauda Equina Claim?

Fortunately, the hospital accepted the failures early on after the claim had been investigated. This meant Richard was entitled to an immediate payment of compensation to help pay for the things he needed. However, he was initially very reluctant to have any help as he had lived a completely different life for a number of years and could not see any way forwards.

We went to see him at home one day and were shocked to see how far downhill he had gone. We were desperately worried about his weight and overall health and thought he was risking his own life by not eating. We knew he needed urgent specialist help so spent considerable time talking to him and his family, encouraging him to get help. He eventually agreed.

As part of the claim, we instructed an experienced case manager who was employed to work with Richard and address his needs.

We worked with the case manager to arrange:

• Weekly physiotherapy with a specialist neuro-physiotherapist, as well as weekly gym and sports sessions to improve his mobility and overall fitness and to get him out of the house;
• Regular sessions with an experienced Clinical Psychologist to help his mood and overall mental health;
• A support worker, who met with him three times a week to support him when going out, so he could start to live a more normal life;

The case manager also arranged for him to have much needed appointments with different doctors and other healthcare professionals including:

• a urologist, who assessed his bladder incontinence and recommended medication to reduce his bladder activity, which meant he did not need to catheterise as often. If that treatment ever stopped being effective, the next option would be Botox injections into his bladder, and he received money to pay for those privately for the rest of his life;
• a colorectal surgeon, who advised him of the options for managing his bowel incontinence including a manual irrigation system, a nerve stimulator and ultimately a colostomy. At the time the case settled, Richard was about to undergo a trial of a nerve stimulator to see if that could restore his lost bowel function. Through the claim he recovered the money needed to fund that privately;
• an NHS dietician, who worked with the case manager and the family to try and increase his food intake and encouraged him to take supplements, so he could become healthier and gain weight;
• a podiatrist and chiropodist to look after his clawed toes and feet which were at risk of skin breakdown and damage because they were numb.

The case manager also bought him equipment including a Wii Fit, so he could exercise at home and work on his balance. He also saw an orthotist who made special shoes which were wider around the toes, so his clawed toes didn’t rub against them.

What Difference Did Making a Claim Have on Richard’s Life?

After the first year of rehabilitation, Richard’s life had changed massively for the better. He still had permanent injuries, but his outlook was much more positive.

He had money, so in the future he could access treatment which might enable him to have better control over his bladder and bowel function. He started eating again and had a more balanced diet with nutritional supplements, so gained weight and had more energy.

As he became more active, through regular physiotherapy and the guidance of his support worker, he started to get fitter and his mobility improved. He started to return to his previous ‘get up and go’ attitude and began to socialise with his family again. He even bought a new car and went out locally, to meet friends at the pub or to go for dinner with his family.

He realised he would need to live in ground floor accommodation when he was older because his mobility was going to deteriorate with age and stairs would become more of a problem. He purchased a house with his mum and dad after the claim settled and paid builders to create a ground floor extension for him to live in so he had his own self-contained space.

Although he could not work, for the first time since he sustained his injuries, he was motivated to think about how he would invest his compensation, so it would last him for the rest of his life. He would need care and help at home over the years, and also help with the DIY and gardening which he would no longer be able to do. The money he received through the claim covered all of these needs and also paid for life-long physiotherapy and additional counselling he would continue to need at different times in the future.

Our role was much wider than investigating his claim and securing compensation for what had happened. We had become a key part of his support network and through listening and asking the right questions, we were able to identify when he significantly deteriorated and quickly put in place what was needed to help him. We were in his corner, supporting and encouraging him as much as he wanted.

We were delighted to receive the following feedback from Richard on conclusion of the claim:

“What can I say about Enable Law! You were my A-Team, in my corner every step of the way. It was a difficult journey and I didn’t know what to expect at the start. But you explained what was happening at each stage and were always on the end of the phone when I needed you. Katherine, you encouraged and supported me though some pretty dark times and I knew when it came to settlement that you would get the best result possible. I had complete trust in you and cannot thank you enough for what you did for me”.

How Could Enable Law Help You?

If you or a loved one have become a victim of spinal injury caused by cauda equina negligence, our expert team could help you get the compensation you deserve. Get in touch with our spinal injury solicitors today to discuss cauda equina claims or other forms of negligence.